Provider Demographics
NPI:1225375660
Name:MOGLE, JENNIFER K (RN-BC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:K
Last Name:MOGLE
Suffix:
Gender:F
Credentials:RN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12503 WILLOWBROOK RD
Mailing Address - Street 2:P. O. BOX 1745
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-2554
Mailing Address - Country:US
Mailing Address - Phone:301-759-5280
Mailing Address - Fax:301-777-5630
Practice Address - Street 1:12503 WILLOWBROOK RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2554
Practice Address - Country:US
Practice Address - Phone:301-759-5280
Practice Address - Fax:301-777-5630
Is Sole Proprietor?:No
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR166401163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health